Receiving supplemental oxygen via a nasal cannula is a common therapy, but keeping the device securely in place can be a constant challenge. When the cannula shifts or becomes dislodged, the prescribed oxygen flow is compromised, potentially leading to a drop in blood oxygen levels. Preventing displacement requires a methodical approach, starting with selecting the right equipment and employing specific fixation techniques for reliable, uninterrupted treatment.
Ensuring Proper Cannula Fit and Adjustment
The foundation of a secure cannula begins with ensuring the equipment is the correct size for the user. A proper fit minimizes movement and reduces the need for external securing methods. The nasal prongs should fit comfortably inside the nostrils but never completely fill the opening. A small gap must remain to allow ambient air to pass through alongside the oxygen flow, meaning the prongs should be approximately half the size of the nostril opening.
The tubing is designed to loop over the ears before meeting under the chin. Using the slider mechanism, the tubing should be adjusted to be snug against the face, but not tight enough to cause skin indentations or discomfort. Two fingers should comfortably fit between the tubing and the chin. For cannulas with curved prongs, the curve should be oriented downward to match the natural shape of the nasal passages and optimize oxygen delivery.
The main oxygen supply line should be positioned to minimize tugging on the facial tubing. Users may route the tubing down their back or drape it across the chest, but slack management is key. Selecting a soft, memory-free tubing material can also improve comfort and help the cannula lie flat against the skin, reducing friction and the tendency to coil or pull away from the face.
Active Methods for Securing the Tubing
When proper fit is insufficient to maintain placement, particularly during sleep or high-activity periods, external fixation becomes necessary. One common and accessible method is using medical tape to anchor the tubing to the cheeks. Fabric-based medical tape, which is gentle on the skin, can be applied over the tubing near the cheekbone or temple to prevent the cannula from pulling out of the nose.
To enhance security and protect sensitive skin, a small piece of hydrocolloid dressing can be placed on the skin first, acting as a barrier before the tape is applied directly over the tubing. This technique is often used for infants and children, who are more likely to inadvertently dislodge the tubing. For strong fixation, caregivers may apply a strip of water-resistant, skin-friendly tape, such as Hy-Tape, over the cannula tubing at the upper cheek area.
A variety of commercial devices are also available that offer specialized support, including nasal clips, facial straps, and specialized adhesive pads. These products are engineered to hold the cannula securely against the face without relying solely on standard medical tape. Adhesive pads, sometimes called “wiggle pads,” are placed on the cheeks, and the cannula tubing is secured to the pad, allowing for temporary removal and repositioning without reapplying tape to the skin.
Securing the long main oxygen line is equally important to prevent the entire system from being yanked. The line can be secured to clothing, bedding, or a mobility device using a simple clothing clip, a safety pin, or Velcro straps. This slack management ensures that any movement or tug on the main hose is absorbed by the clip rather than transferring tension directly to the nasal prongs.
Protecting the Skin from Pressure and Irritation
Long-term cannula use and necessary securement techniques can lead to skin irritation, making preventative skin care a priority. The areas behind the ears and the cheeks are vulnerable to pressure and friction from the tubing. Cushioned ear protectors, soft foam, or small pieces of gauze can be used to pad the tubing where it rests over the ears, distributing the pressure more evenly.
Before applying any adhesive tapes, a protective barrier should be used on the skin to minimize the risk of skin breakdown. Products like skin prep wipes or spray create a thin film that protects the skin from the adhesive. For moisturizing the face, only water-based lotions or gels should be used, as petroleum or oil-based products can pose a fire risk in the presence of oxygen and may degrade the tubing material.
Routine skin checks are necessary, focusing on the skin under the nose, behind the ears, and on the cheeks, to look for redness or signs of pressure sores. If an area becomes irritated, rotate the points of pressure or adjust the position of the tubing slightly to allow the skin to recover. The prongs should also be gently washed with soap and water once or twice a week, and the entire cannula should be replaced monthly to maintain hygiene and material integrity.